Published Date: 2012-06-11 16:47:57
Subject: PRO/AH/EDR> Rabies - India (05): mortality estimates
Archive Number: 20120611.1164493
RABIES - INDIA (05): MORTALITY ESTIMATES
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 10 Jun 2012
From: Merritt Clifton <firstname.lastname@example.org> [edited]
Further to my ProMED-mail posting: "Rabies - India (04): mortality estimates 20120610.1163188", I have today [10 Jun 2012] reviewed 535 reports of "dog menace" published by Indian news and medical media since 2005 to see what more might be abstracted or deduced.
Firstly, in historical order, according to The Statesman of 11 Jul 2011, a Major Harvey, who was the director of the Pasteur Institute at Kasauli in July 1911, reported that through "personal inquiries" he had learned "that out of 3289 Indians bitten by rabid dogs or dogs suspected of being rabid, only 1636 came for treatment." Divorced from context over time, Major Harvey's finding may have had legs.
The human population of India as of 1907, the most recent census year preceding 1911, was approximately 219 million. The human population of India as of 2003 was 1.1 billion, just about 5 times larger.
A 2003 report by the Bangalore-based Association for Prevention and Control of Rabies in India (APCRI), sponsored by the World Health Organisation (WHO), found 20 565 deaths from rabies in 2003, with over 96 per cent transmitted by dogs, mostly strays.
Multiplying Major Harvey's 3289 Indians bitten by rabid dogs by 5 to account for population growth produces a total of 16 445. Add the 3000 that the APCRI added to account for unreported cases, over the vehement opposition of Blue Cross of India chief executive Chinny Krishna (as recounted in my previous posting), and the total comes to 19 445, which is close enough to 20 565 for dancing and horseshoes, and too close to get to a rabid dog. Split the difference and one gets exactly 20 000. This might be just coincidence and circumstantial evidence at best, but as Henry David Thoreau remarked, "Some circumstantial evidence is very strong, as when you find a trout in the milk."
In 2009, Tamil Nadu recorded 3 deaths against 263 across the country, and in 2010, they recorded 2 deaths against 162 nationally (source: National Health Profile 2010).
The figure of 223 human rabies deaths in India in 2011, cited in the Lok Sabha by Indian health minister Gulam Nabi Azad on 29 Apr 2012, would appear to come from National Health Profile 2011.
How complete might these numbers be? My search through the 535 articles produced the following annual tallies of death accounts:
Obviously, not every human rabies death is reported by English-language news media. But equally obviously, the totals that have been reported are markedly lower than the National Health Profile numbers: cumulatively, 70 per cent lower. Thus, if the National Health Profile numbers are low at all, the undercounting cannot be demonstrated from other reportage.
I concluded my previous posting by mentioning that data from Andhra Pradesh and Goa states, released after rabies outbreaks in 2011, later projected a range of 2000 to 3150 human rabies deaths per year for the whole of India, if all states were afflicted to the same extent. My search of the 535 articles produced recent human rabies death totals from several other states, including Uttar Pradesh, Tamil Nadu, and Manipur. These respectively project 365, 72, and 900 human rabies deaths per year for the whole of India. Putting all of the state totals together projects about 415 human rabies deaths per year for the whole of India.
Editor, Animal People
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[ProMED-mail thanks Merritt Clifton for this further analysis of estimates of human rabies mortality in India. The need for rabies virus infection of humans to become a notifible disease in India becomes ever more apparent.
A map of the states of India can be accessed at: http://www.mapsofindia.com/maps/india/india-political-map.htm. - Mod.CP]